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Valvular heart disease
Original research
Presentation and outcomes of mitral valve surgery in France in the recent era: a nationwide perspective
  1. David Messika-Zeitoun1,
  2. Pascal Candolfi2,
  3. Maurice Enriquez-Sarano3,
  4. Ian G Burwash1,
  5. Vincent Chan4,
  6. Jean-Francois Philippon5,
  7. Jean-Manuel Toussaint6,
  8. Partrick Verta7,
  9. Ted E Feldman7,
  10. Bernard Iung8,
  11. David Glineur4,
  12. Jean-Francois Obadia9,
  13. Alec Vahanian10 and
  14. Thierry Mesana4
  1. 1Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
  2. 2Edwards Lifesciences, Nyon, Switzerland
  3. 3Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
  4. 4Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
  5. 5Département D’Epidémiologie et de Biostatistiques, Ecole des Hautes Études en Santé Publique, Paris, France
  6. 6International Health Market Trends, Paris, France
  7. 7Edwards Lifesciences, Irvine, California, United States
  8. 8Cardiology, Bichat Hospital, Paris, France
  9. 9Cardiothoracic Surgery Department, Louis Pradel Hospital, Lyon-Bron, France
  10. 10University Paris VII, Faculté de Médecine Paris-Diderot, Paris, France
  1. Correspondence to Dr David Messika-Zeitoun; dmessika-zeitoun{at}ottawaheart.ca

Abstract

Objectives Unbiased information regarding the surgical management of patients with mitral regurgitation (MR) at the nationwide level are scarce and mainly US-based. The Programme de Médicalisation des Systèmes d’Information, a mandatory national database, offers the unique opportunity to assess the presentation and outcomes of all consecutive mitral valve (MV) surgeries performed in France in the contemporary era.

Methods We collected all MV surgeries performed for MR in France in 2014–2016. MR aetiology was classified as degenerative (DMR), secondary (SMR) or Other (rheumatic or congenital disease and infective endocarditis).

Results During the 3-year period, 18 167 MV surgeries were performed in France (55% repair and 45% replacement; 52% isolated). Age was 66±12 years and 59% were male. Aetiology was DMR in 42%, SMR in 16% and other in 42% including 19% with uncertain aetiologies. Overall, in-hospital mortality was 6.5% and increased with age, female gender, Charlson Comorbidity Index, type of surgery (replacement vs repair), associated surgery (combined vs isolated) and MR aetiology (all p<0.01). In-hospital mortality and rate of death/readmission for heart failure (HF) at 1 year were 3.4% and 13%, respectively for DMR (2.4% and 11% for isolated DMR) and 7.8% and 27%, respectively for SMR (5.5% and 23% for isolated SMR). Repair rate was 55% overall, 68% in DMR and 72% for isolated DMR surgery (70% of all DMR). Repair rates decreased with age, Charlson Comorbidity Index and female sex (all p<0.0001).

Conclusion In this cross-sectional contemporary prospective nationwide database, in-hospital mortality and 1 year rate of death and HF readmission were considerable overall and in all subsets. Repair rates were suboptimal overall especially in the elderly and women subsets. These results underline the need to develop strategies to improve management and outcomes of patients with both DMR and SMR.

  • mitral regurgitation
  • cardiac surgery
  • mitral valve prolapse
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/openhrt-2020-001339

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    Footnotes

    • Contributors Conception and design, or analysis and interpretation of data: DM-Z, PC, J-FP, J-MT. Drafting the article or revising it critically for important intellectual content: DM-Z, PC, ME-S, IGB, VC, PV, TEF, BI, DG, J-FO, AV, TM. Final approval of the version to be published: DM-Z, PC. Contributors as being responsible for the overall content as guarantors: DM-Z.

    • Funding This study was funded through a research contract between International Health Market Trends and Edwards Lifesciences. DM-Z had full access to the data and performed the statistical analyses independently.

    • Competing interests DM-Z is a consultant for Edwards Lifesciences, Mardil and Cardiawave and receives research grants from Edwards Lifesciences and Abbott vascular. PC is an Edwards Lifesciences employee. M-ES has received research grants from Edwards Lifesciences. PV is an Edwards Lifesciences employee. TEF is an Edwards Lifesciences employee. BI has received consultant fees from Edwards Lifesciences and speaker’s fees from Boehringer Ingelheim and Novartis. J-FO has received Consultant fees from Landanger, Delacroix-Chevalier and speaker’s fees from Abbott, Medtronic, Sanofi. AV has received speaker’s fees from Edwards Lifesciences.

    • Patient consent for publication Not required.

    • Ethics approval Ethical approval was not required as all data in the PMSI database are anonymised.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be available on valid request.